Healthcare Provider Details

I. General information

NPI: 1992869721
Provider Name (Legal Business Name): SUSAN WYNN PETERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NEW LEICESTER HWY
ASHEVILLE NC
28806-1048
US

IV. Provider business mailing address

PO BOX 2063 SUITE A
LEICESTER NC
28748-2063
US

V. Phone/Fax

Practice location:
  • Phone: 828-253-3717
  • Fax: 828-252-8072
Mailing address:
  • Phone: 828-622-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200101115
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: